NSE 13 week 2 - Lecture notes 2 PDF

Preview

Summary

Self-review anatomy and physiology (know landmarks and bony prominences) ● Functions of the MSK system ○ Support and protection ○ Movement ○ Hematopoiesis (produce the red blood cells) ○ Storage of minerals ● Joints - where bones meet (functional unit) ○ Non Synovial joints - immovable or slightly m...

Description

1. Self-review anatomy and physiology (know landmarks and bony prominences) ●

●

●

●

Functions of the MSK system ○ Support and protection ○ Movement ○ Hematopoiesis (produce the red blood cells) ○ Storage of minerals Joints - where bones meet (functional unit) ○ Non Synovial joints - immovable or slightly movable ○ Synovial joints - freely movable, synovial fluid, bones are separated from each other ■ Cartilage ● avascular, receiving nourishment from synovial fluid ● Tough, firm consistency, flexible ● Cushions the bones and provides a smooth surface to facilitate movement ■ Ligaments ● Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions Muscles ○ Smooth, Cardiac, and Skeletal ■ Skeletal - conscious control, attached to skeleton by tendons ■ Produce the following movements ● Flexion, extension, abduction, adduction, pronation, supination, circumduction, inversion, eversion, rotation, protraction, retraction, elevation, depression, lateral bend, dorsiflexion, plantarflexion, ulnar & radial deviation The cervical spine and spine ○ Four curves “double S” ○ 33 vertebrae ■ Cervical spine (7) ■ Thoracic spine (12) ■ Lumbar spine (5) ■ Sacral spine (5) ■ Coccyx (4)

2. Outline the developmental changes, cultural considerations and health promotion strategies ● ● ● ● ● ● ●

Posture and body mechanics Exercise Diet (adequate intake of calcium and vit D) Calcium and vitamin D Caffeine and alcohol Smoking Talk with health care professionals

3. Describe and assess lordosis, kyphosis and scoliosis ● ●

Lordosis ○ Pregnancy, lumbar, Kyphosis ○ Curvature in thoracic, old people

●

Scoliosis ○ lateral curvature of thoracic and lumbar segments of the spine. ○ Usually with some rotation of involved vertebral bodies ■ Functional scoliosis - flexible, apparent on standing and disappears on forward bending. ■ Structural scoliosis - fixed; shows both on standing and on bending forward.

4. Outline and practice subjective questions and identify critical findings ● ● ● ● ● ● ●

Joints - pain, stiffness, swelling, heat, redness, limitation of movement Knee joint (if injured) Muscles - pain, weakness Bones - pain, deformity, trauma Functional assessment Self-care behaviours - exercise, diet, weight gain, occupational hazards, medications Critical findings ○ Fractures - sharp pain increases with movement ○ Compartment syndrome ○ Report immediately, monitor VS and peripheral vascular circulation

5. Identify guidelines for preparation of objective data collection ● ● ● ●

Drape for full visualization of the body part you are examining Head to toe approach - bilateral Proximal to distal (if the persona have abnormal finding then you should inspect the joint below it) Assess joint above and below the affected joint ○ Inspection ■ Size & contour ■ Colour, swelling, masses ■ Deformities ● Dislocation (one or more bones in a joint being out of position) or subluxation (partial dislocation of a joint) ● Contracture - shortening of muscle ● Ankylosis - stiffening of joint ○ Palpation ■ Bony articulations, joint capsule and muscle ● Temperature (use the dorsal of your hand) ● Tenderness (palpate full joints) ● Swelling, atrophy, masses, edema/palpable fluid, muscle spasm ○ Range of Motion (ROM) ■ Active ROM (voluntary) ■ Stabilize joint proximal to area being moved ■ Note findings ● pain/tenderness - need to ask the client ● Crepitation - audible and palpable crunching/grating ■ ROM ● Full of limited ROM ● Know the expected ranges ● 110 degree usually ○ Testing muscle strength ■ Strength of muscle groups of joint ■ Repeat ROM of joints

■

● Apply force against movement ● Note : full resistance, equal bilaterally (normal) Scale 0-5 ● 0 : no ROM/contraction of muscle ● 1 : slight contraction ● 2 : full ROM, with passive motion ● 3 : full ROM, slight resistance ● 4 : full ROM, some resistance ● 5 : full ROM, full resistance

6. Practice inspection, palpation, ROM and muscle strength testing on TMJ, cervical spine, upper extremities (including Phalen’s test, tinel’s sign), lower extremities, and spine ●

●

●

●

Temporomandibular joint (TMJ) ○ Inspect ■ Size & contour, colour, swelling, masses/deformities ○ Palpation ■ Temperature, tenderness, sweling, masses ■ Place your two fingers over TMJ and ask client to open and close jaw ○ ROM ■ Vertical motion, lateral motion and protrusion and retraction ○ Muscle strength ■ Repeat ROM and apply resistance (all movements except retraction) ■ Test CN V - trigeminal - clench teeth The cervical spine - neck ○ Inspect ■ Size & contour, colour, swelling, masses/deformities ■ Alignment of head and neck ○ Palpate ■ Spinous process and sternomastoid, trapezius and paravertebral muscle for symmetry ■ Temperature, pain, swelling, spasm, masses/deformities ○ ROM ■ Flexion, hyperextension, lateral bend, rotation ○ Muscle strength testing ■ All ROM movements (also tests CN XI - spinal nerve) The shoulder ○ Glenohumeral joint (ball & socket) ○ Inspect ■ symmetry/size/contour, colour, swelling, deformity/masses/atrophy ○ Palpate ■ spasm/atrophy, swelling/edema, temperature, masses/deformities, pain ○ ROM ■ Flexion, hyperextension, internal and external rotation, abduction, adduction ○ Muscle strength testing ■ Shrug, flex, extend, adduct, and abduct (also, tests CN XI - spinal nerve) The elbow - hinge joint ○ Palpate landmarks ■ Olecranon process of ulna and medial & lateral epicondyles of the humerus ○ Inspect ■ symmetry/size/contour, deformities/masses/atrophy, swelling, and

colour Palpate ■ Temperature, swelling/edema, muscle spasm/atrophy, masses, pain ○ ROM ■ Flexion, extension, pronation, supination ○ Muscle strength testing (flex and extend) Wrist and hand ○ Radiocarpal joint ■ Radiocarpal joint ● Articulation of radius, ulna, carpal bones ■ Inspect ● symmetry/contour/shape, deformities/masses/nodules/atrophy, swelling, colour ■ Palpate ● Temperature, swelling/edema, muscle spasm/atrophy, masses/deformities, pain ■ Wrist ● Flexion, extension, hyperextension, ulnar and radial deviation ■ Fingers ● Flexion, hyperextension, abduction (first and spread) ■ Muscle testing of wrist (flex and extend) ○ Additional tests ■ Phalen test ● Hold both hands back-to-back ● Flexing wrist at 90 degrees x 60 sec ● Acute flexion of wrist should produce no symptoms ○ Can reproduce numbness and burning sensation associated with carpal tunnel syndrome ■ Tinel’s sign ● Direct percussion of the median nerve ● Should produce no symptoms ○ Can reproduce burning and tingling sensation associated with carpal tunnel syndrome Hip joint (ball & socket) ○ Inspect ■ symmetry/size, colour, swelling, deformities/masses/atrophy ○ Palpate ■ Temperature, swelling/edema, masses, pain, muscle spasm/atrophy ○ Range of motion ■ Flexion (knee straight and bent), abduction, adduction, internal and external rotation, hyperextension while standing) ○ Muscle strength testing ■ Flex, extend, abduct and adduct Knee joint ○ Articulation of 3 bones ○ Inspection ■ symmetry/size/contour/deformities, colour, swelling, masses ○ Palpation ■ Temperature, swelling/edema/fluid, muscle spasm/atrophy, masses/nodules, pain ○ ROM - flexion and extension ○ Muscle testing ■ All ROM and can also ambulate for strength and flexion while standing Ankle and foot ○ Ankle : hinge joint and articulation of tibia, fibula and talus ○

●

●

●

●

○ ○

●

Medial and lateral malleoli Inspection ■ symmetry/size/contour, deformities/masses/atrophy, colour, swelling ○ Palpation ■ Temperature, swelling/edema, muscle spasm, atrophy, amsses, pain ○ ROM ■ Dorsiflexion, plantar flexion, inversion and eversion and flex and extend toes ○ Muscle testing - dorsiflexion and plantar flexion The spine ○ Spection ■ Alignment, curvature, colour, swelling, masses/deformities ○ Palpation ■ Temperature, swelling, masses, pain ■ Spinous processes : straight ■ Paravertebral muscles : firm, pain, spasm ○ ROM ■ Flexion, hyperextension, lateral bend, rotation ○ Muscle testing - flexion and extension

*refer to class powerpoint slides for details on muscle strength testing 7. Test CNXI (spinal accessory nerve) ●

CN XI (spinal accessory nerve) ○ Examine the sternomastoid and trapezius muscles for equal size ○ Check equal strength by asking the patient to rotate the head forcibly against resistance applied to the side of the chin ○ Then ask the patient to shrug the shoulders against resistance ○ Normally equally strong on both sides

8. Verbally report and document subjective and objective findings

Practice questions Q : In the following list, which assessment would occur first? A : asking client about pain of the joints Q: upon inspection of the right hand, swelling is observed on the distal interphalangeal joint. What is the RN’’s next step? A: inspect the distal interphalangeal joint on the left hand (to see it’s symmetrical, abnormal or normal) **When document, the right designation is Nursing student year one. Q: during an assessment for the spine the patient would be asked to: A: flex, extend, lateral bend Q: what should b3 continually assessed following a femur fracture? Select all that apply A: blood pressure, numbness in feet, dorsalis pedal pulses, skin temperature distal to fracture...